Nose | Primary Rhinoplasty

One of the most popular procedures in the United States, primary rhinoplasty refers to a first-time nose job, as opposed to a secondary or revision procedure. It’s performed to reshape and resize the nasal structure, so it fits in with your other features and achieves a more attractive facial appearance.

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Reasons for a primary rhinoplasty

There are countless reasons why men and women of all ages choose to undergo a primary cosmetic rhinoplasty. Some of the most common ones include:

A nose that’s too large or small for your face

A nasal bridge with a hump or bump

An abnormally wide nose

A protruding, overly large, bulbous or drooping nasal tip

Flared or pinched nostrils

A crooked or asymmetrical nasal structure

Preparing for your Primary Rhinoplasty

Your satisfaction with your primary rhinoplasty relies heavily on how your plastic surgeon prepares for your procedure. As such, Dr. Rahban spends a substantial amount of time with you prior to surgery, discussing the imperfections you’d like addressed and reviewing your expected results.

When patients are unhappy with their appearance following a nose job, it is often due to a miscommunication with their surgeon. Dr. Rahban avoids this by getting crystal clear about your vision before the procedure even begins. The two of you will go over every step of the procedure and he will make numerous illustrations in order to make certain you truly understand what will be done.

While he may use images of various noses to help you understand ideal shape, size and profile you should consider, he is opposed to computer morphing of the patient’s own nose, aka Photoshop. He feels that this tool is better for the surgeon than the patient, as it is used to “close the deal.” Understandably, patients’ greatest apprehension is what they will look like, and the Photoshop image is very misleading and as such has “results may vary” all over it. This will only create a false sense of security, and when your nose looks nothing like the image, you will be sadly disappointed.

The best predictor of what your nose will look like is looking at numerous before and after pictures of your surgeon’s work. If you like 70% of their work, the two of you are likely on same aesthetic page. Dr. Rahban will offer his guidance regarding which nose will appear the most natural, and he’ll make sure you’re both on the same page before scheduling your operation.

What to Expect during your Primary Rhinoplasty

There are two main approaches to the primary rhinoplasty: the open approach and the closed approach.

With open rhinoplasty, Dr. Rahban will create an incision along the columella, which is the cartilage that separates your nostrils. From there, he will lift the skin to expose the underlying nasal structure, where he will reshape and resize your nose.

With closed rhinoplasty, Dr. Rahban will make incisions inside the nose only, through which he will reshape the nose.

In general, he is a strong proponent of the open approach, as he believes it gives him the greatest accuracy and control of the underlying structures, reserving the closed technique for minor changes. Both of these techniques are very effective, and the right one for you will depend on the shape of your nose and your aesthetic objectives.

Once the incision has been made, Dr. Rahban will very precisely remove excess cartilage and bone as well as reshape your native nasal structure to create a new nose that is objectively more attractive and in better balance with your face. Dr. Rahban believes in what he terms is a reconstructive rhinoplasty as opposed to the standard mill reductive rhinoplasty.

Most surgeons who don’t do a lot of rhinoplasties tend to do a quick surgery where the main objective is to remove structure like cartilage and bone. Therefore, it should not come as a surprise that these noses tend to collapse with time and lead to the classic “done look” and difficulty breathing. Almost all of his revision cases are due to this type of rhinoplasty.

During your reconstructive Beverly Hills rhinoplasty, Dr. Rahban uses cartilage, usually from the septum, to add reinforcement to the refined structure he has created. Like a building, your nose will need support to keep it looking natural over time. Your nose will not only be more refined but more importantly strong and long lasting. This type of rhinoplasty takes more time and expertise, hence why few surgeons use this technique.

Throughout the surgery, Dr. Rahban will be referring to images of your nose and his notes to make sure he achieves an outcome that is in alignment with what you discussed pre-operatively. Most importantly, he will use a conservative approach to avoid overcorrecting your nose – ensuring that your results appear very natural. Once the procedure is complete, he will close the incisions meticulously to ensure that your resulting scars are as faint and imperceptible as possible.

Your Recovery

After your rhinoplasty, you can expect the first week to be the key during your recovery period. You will need to treat the area very gently to avoid harming your new nasal structure and interrupting the healing process. To that end, you’ll be advised to wear buttoned shirts, sleep with your head elevated, eat soft foods, take baths rather than showers, and avoid salty food and blowing your nose. In addition, you’ll need to carefully change the gauze outside your nose as directed by Dr. Rahban.

Throughout this initial period, it’s normal to experience some swelling, bruising and stuffiness. Though uncomfortable, these effects are only temporary and should subside as you continue to heal. Rhinoplasty is generally not considered painful, but instead could be described as uncomfortable. With that said, certain side effects are not normal and require immediate medical attention. If you experience a high fever, severe bleeding, a significant injury to the nose or a considerable increase in pain that cannot be relieved with your prescribed medications, you should contact Dr. Rahban immediately.

About one week into your healing process, you’ll return to Dr. Rahban’s office for your first post-operative appointment. During that meeting, he will remove any internal and external dressings so he can evaluate your nose, assess your progress and ensure that you’re healing properly. He will also answer any questions you may have about your recovery and provide you with additional aftercare instructions as needed. Depending on how swollen you are, he may apply tape on your nose to help the swelling resolve more quickly. From that point on, you will be seeing him several more times, as the healing process takes up to one year and he is a very hands on surgeon.

Primary Rhinoplasty FAQ

While all surgeries have risks like bleeding and infection, there are several risks that are specific to rhinoplasty. These risks include:

Scarring. If a rhinoplasty incision is not closed with the utmost of care, the scar can be visible.

Trouble breathing. Rhinoplasty can weaken the nasal structure and cause substantial breathing problems if not performed expertly.

Dissatisfaction due to asymmetry. The number 1 risk of rhinoplasty is that the patient will not have a nose that is perfect. No matter how amazing your rhinoplasty is, no nose will ever be perfect from every angle.

Yes, breathing can be improved with a well-performed rhinoplasty that addresses the structural issues of the nose in addition to the esthetic ones. Breathing can also be substantially worsened by a rhinoplasty performed by a surgeon who is not dedicated to a reconstructive surgery that protects your long term breathing health.

A rhinoplasty can range extensively in price, anywhere from $5,000 - $20,000. Why is there so much variance? Because each surgeon can manipulate the cost by varying what is included in the price. For instance, if a surgeon operates at a center with lower accreditation, less modern medical equipment, or does not use a board certified anesthesiologist, your cost will be less. The question to ask yourself is “am I comfortable with a lower cost surgery, knowing that you get what you pay for?”

The single most important thing you can do to prepare for your rhinoplasty is to do extensive research on the surgeons you are considering. Picking the right surgeon will be the best predictor of your satisfaction and outcome. Preparing for rhinoplasty includes making sure you are physically and mentally ready for the surgery and recovery. One critical component of being prepared for a nose job is understanding that patience is necessary. It can take over a year for the last of the swelling to disappear, before you will see your final results. You should be in the best health possible, have realistic expectations, and also make sure you are comfortable with the financial component of the surgery.

You cannot blow your nose immediately after rhinoplasty because you will have a cast on the outside of your nose, and packing on the inside of your nose. Once the packing is removed, you will be able to gently blow your nose.

Rhinoplasty recovery can be thought of as 3 phases. The first phase lasts 1 - 2 weeks and is the part of recovery when you’ll have the most swelling and bruising, and will want to take time off work and have help around the house. The second phase lasts 6 - 8 months, during which you will have almost no bruising and most of your swelling will dissipate. You’ll be able to go back to work and return to many of your normal activities, although we’ll ask you to refrain from strenuous exercise. The last phase of rhinoplasty recovery can last up to a year or two. This is the phase during which your final swelling will disappear, and you can see your true rhinoplasty results.

There are several factors that make someone a good candidate for rhinoplasty, including being in good overall health and having realistic expectations. Beyond that, a candidate for rhinoplasty is someone who is able to communicate well with their surgeon to ensure that they are on the same page about their desired results.

A mommy makeover is fairly unique in that it involves several cosmetic procedures performed in a single visit. This is convenient for our patients because when you have several cosmetic procedures in a single session, you have only a single period of recovery. It is also cost-saving, since the combination of treatments can reduce overall surgery expenses including anesthesia and operating room costs.

Both an open and a closed rhinoplasty involve incisions inside the nose. The difference is that closed rhinoplasties also have one incision through the columella - the area between your nostrils at the base of the nose. For most patients, Dr. Rahban chooses an open rhinoplasty. This extra incision allows for better access to the interior of the nose, which gives Dr. Rahban the ability to perform your rhinoplasty with a level of precision and advanced techniques that are not possible with a closed rhinoplasty.

The question of driving home after a medical or surgical procedure depends on the type of anesthesia you’ve had. For rhinoplasty, your anesthesia will be strong to keep you comfortable and unaware of the surgery. You will not be able to drive home after your rhinoplasty. Remember also that you cannot drive while taking many prescription pain medications, so you’ll need to stop taking those before you can drive.

Dr. Rahban will ensure you have pain medication for the initial phase of recovery, although rhinoplasty is truly not a painful operation in general. Most of our patients find they are able to stay comfortable with over the counter pain medicine.

Come in for a Consultation with Dr. Rahban

When Dr. Rahban does a consultation with a prospective patient, he wants it to be two things above all others: thorough and honest. He will find out from
you just what you want from cosmetic surgery. And he will tell you honestly if you can get the result you want, and how he can best help you do so.